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Thoas Fioretos

Thoas Fioretos

Research team manager

Thoas Fioretos

Transcriptional landscape of B cell precursor acute lymphoblastic leukemia based on an international study of 1,223 cases


  • Jian Feng Li
  • Yu Ting Dai
  • Henrik Lilljebjörn
  • Shu Hong Shen
  • Bo Wen Cui
  • Ling Bai
  • Yuan Fang Liu
  • Mao Xiang Qian
  • Yasuo Kubota
  • Hitoshi Kiyoi
  • Itaru Matsumura
  • Yasushi Miyazaki
  • Linda Olsson
  • Ah Moy Tan
  • Hany Ariffin
  • Jing Chen
  • Junko Takita
  • Takahiko Yasuda
  • Hiroyuki Mano
  • Bertil Johansson
  • Jun J. Yang
  • Allen Eng Juh Yeoh
  • Fumihiko Hayakawa
  • Zhu Chen
  • Ching Hon Pui
  • Thoas Fioretos
  • Sai Juan Chen
  • Jin Yan Huang

Summary, in English

Most B cell precursor acute lymphoblastic leukemia (BCP ALL) can be classified into known major genetic subtypes, while a substantial proportion of BCP ALL remains poorly characterized in relation to its underlying genomic abnormalities. We therefore initiated a large-scale international study to reanalyze and delineate the transcriptome landscape of 1,223 BCP ALL cases using RNA sequencing. Fourteen BCP ALL gene expression subgroups (G1 to G14) were identified. Apart from extending eight previously described subgroups (G1 to G8 associated with MEF2D fusions, TCF3–PBX1 fusions, ETV6–RUNX1–positive/ETV6–RUNX1–like, DUX4 fusions, ZNF384 fusions, BCR–ABL1/Ph–like, high hyperdiploidy, and KMT2A fusions), we defined six additional gene expression subgroups: G9 was associated with both PAX5 and CRLF2 fusions; G10 and G11 with mutations in PAX5 (p.P80R) and IKZF1 (p.N159Y), respectively; G12 with IGH–CEBPE fusion and mutations in ZEB2 (p.H1038R); and G13 and G14 with TCF3/4–HLF and NUTM1 fusions, respectively. In pediatric BCP ALL, subgroups G2 to G5 and G7 (51 to 65/67 chromosomes) were associated with low-risk, G7 (with ≤50 chromosomes) and G9 were intermediate-risk, whereas G1, G6, and G8 were defined as high-risk subgroups. In adult BCP ALL, G1, G2, G6, and G8 were associated with high risk, while G4, G5, and G7 had relatively favorable outcomes. This large-scale transcriptome sequence analysis of BCP ALL revealed distinct molecular subgroups that reflect discrete pathways of BCP ALL, informing disease classification and prognostic stratification. The combined results strongly advocate that RNA sequencing be introduced into the clinical diagnostic workup of BCP ALL. four decades, most of the recurring chromosomal abnormalities, including aneuploidy, chromosomal rearrangements/gene fusions (e.g., ETV6–RUNX1, BCR–ABL1, and TCF3–PBX1), and rearrangements of KMT2A (previously MLL), were identified by.


  • Translational Genomic and Functional Studies of Leukemia
  • BioCARE: Biomarkers in Cancer Medicine improving Health Care, Education and Innovation
  • Genetic and epigenetic studies of pediatric leukemia

Publishing year







Proceedings of the National Academy of Sciences of the United States of America





Document type

Journal article


National Academy of Sciences


  • Cancer and Oncology


  • Gene fusion
  • Gene mutation
  • RNA-seq
  • Subtypes



Research group

  • Translational Genomic and Functional Studies of Leukemia
  • Genetic and epigenetic studies of pediatric leukemia


  • ISSN: 0027-8424